Successful incorporation of robotic surgery into gynecologic oncology fellowship training

Background

The increasing role of robotic surgery in gynecologic oncology may impact fellowship training. The purpose of this study was to review the proportion of robotic procedures performed by fellows at the console, and compare operative times and lymph node yields to faculty surgeons.

Methods

A prospective database of women undergoing robotic gynecologic surgery has been maintained since 2008. Intra-operative datasheets completed include surgical times and primary surgeon at the console. Operative times were compared between faculty and fellows for simple hysterectomy (SH), bilateral salpingo-oophorectomy (BSO), pelvic (PLND) and paraaortic lymph node dissection (PALND) and vaginal cuff closure (VCC). Lymph nodes counts were also compared.

Results

Times were recorded for 239 SH, 43 BSOs, 105 right PLNDs, 104 left PLNDs, 34 PALND and 269 VCC. Comparing 2008 to 2011, procedures performed by the fellow significantly increased; SH 16% to 83% (p < 0.001), BSO 7% to 75% (p = 0.005), right PLND 4% to 44% (p < 0.001), left PLND 0% to 56% (p < 0.001), and VCC 59% to 82% (p = 0.024). Console times (min) were similar for SH (60 vs. 63, p = 0.73), BSO (48 vs. 43, p = 0.55), and VCC (20 vs. 22, p = 0.26). Faculty times (min) were shorter for PLND (right 26 vs. 30, p = 0.04, left 23 vs. 27, p = 0.02). Nodal counts were not significantly different (right 7 vs. 8, p = 0.17 or left 7 vs. 7, p = 0.87).

Conclusions

Robotic surgery can be successfully incorporated into gynecologic oncology fellowship training. With increased exposure to robotic surgery, fellows had similar operative times and lymph node yields as faculty surgeons.     

Cesárea a petición de la embarazada

Objetive

: To know Spanish Obstetrics and Gynaecology Society (SEGO) members about cesarean section on request.

Method

Three questions appeared on SEGO web: 1) If a normal primigravid with a term, cephalic presentation foetus ask you for a caesarean section, would you do it?; 2) If a normal primigravid with a term, breach presentation foetus ask you for a caesarean section, would you do it?; 3) If a woman on her normal third pregnancy with two previous vaginal and with a term, breach presentation foetus ask you for a caesarean section, would you do it? Questions were asked in May 2006 and answers were collected 19^th October 2006. Data analysis was processed with web page statistic method.

Results

Among the 5300 members of SEGO, 1222 contacted the web page (23%). To question n° 1, 57.8% answered no, 24.8% yes and 17.4% had no answer. To question n° 2, 6.1% answered no, 93.8% yes and there were no abstention. To n° 3 question, 16.7% said no, 74.5% said yes and 8.8% has no opinion.Results are commented, advantages and disadvantages of caesarean are discussed as well as sanitary consequences of such an indication.     

Prevalence of Chikungunya,Dengue and Zika viruses in blood donors: a systematic literature review and meta-analysis

BackgroundBlood transfusion centres should understand the epidemiology of emerging diseases that are transmissible through the transfusion of blood components. The risk of transmission of arboviruses through this route has become apparent in recent years. The aim of our study is to summarise the reported prevalence (viraemic rate, seroprevalence and/or antigen detection) of Chikungunya (CHIKV), Dengue (DENV) and Zika (ZIKV) viruses in blood donors according to screening test used and world region.Materials and methodsWe conducted a systematic literature review and meta-analysis having searched for information in the main bibliographic databases (MEDLINE, Embase, and Scopus). The prevalence for each of the viruses was calculated according to the screening test used and geographic location.ResultsWe included 18 records on CHIKV, 71 on DENV, and 27 on ZIKV. The highest prevalences of RNA for CHIKV were 1.9% in Puerto Rico (2014), 1.0% in Thailand (2009), and 1.0% in French Polynesia (2014–15). The highest prevalences of RNA for DENV were 5.5% in Saudi Arabia (2015–16), 2.3% in Madeira, Portugal (2012–13), and 0.6% in Brazil (2012). The highest prevalences of RNA for ZIKV were 2.8% in French Polynesia (2013–14), 2.7% in Brazil (2015–16), and 1.8% in Martinique (2016). Overall seroprevalence, as assessed by IgG antibodies, was 21.6% for CHIKV, 24.0% for DENV, and 5.1% for ZIKV.DiscussionOur study shows a high proportion of donors who are viraemic and asymptomatic, especially during outbreaks, with prevalences surpassing 5% for DENV, 1% for CHIKV, and 2% for ZIKV. These data confirm a clear threat to blood transfusion safety. The elevated seroprevalence for these three arboviruses is also indicative of their wide circulation in populations, correlating with an increased risk of infected but asymptomatic donors. Health centres and institutions must address this threat, especially in tropical regions where the biggest outbreaks occur.     

Opioid-based micro and nanoparticulate formulations: alternative approach on pain management

Context Opioids have been used as the reference treatment on chronic pain. However, they are related to serious adverse effects which affect the patient compliance to treatment, as well as, his quality of life. Particulate formulations have been investigated as an alternative to improve opioid efficacy and safety. Objective Summarise the available studies concerning micro and nanoencapsulated opioid formulations discussing their biopharmaceutical characteristics, such as composition, size, in vitro release, pharmacokinetic and antinociceptive profile. Methods Papers available in 1995–2015 at Medline, Science Direct and Web of Science databases were collected and assessed. Searches were performed using varied combinations of the keywords of this work. Results Opioid-loaded particles showed prolonged drug release with maintenance of serum therapeutic concentrations and extended analgesia when compared with the free drugs. The side effects incidences were reduced or maintained the same. Conclusion Particulate formulations can significantly increase both potency and safety profiles of opioids.     

Ternary Blends for Self-Compacting Mortars Production Composed by Electric Arc Furnace Dust and Other Industrial by-Products

This study is framed within the circular economy model through the valorisation of industrial by-products. This research shows the results of producing self-compacting mortars (SCMs) with electric arc furnace dust (EAFD) and other industrial by-products such as fly ash, conforming (FA) or not conforming (NcFA), from coal-fired power plants, or recovery filler (RF) from hot-mix asphalt plants. Three batches of SCMs, each with one industrial-by product (FA, NcFA, or RF), and three levels of EAFD ratio incorporation (0%, 10%, 20%), were tested. An extra batch with a greater amount of FA was manufactured. When the incorporation ratio of EAFD rose, the mechanical strength decreased, due to the presence of a calcium zinc hydroxide dihydrate phase; nevertheless, this decrease diminished over time. All SCM mixes, except the 40C 40FA 20 EAFD mix, were above 20 MPa at 28 days. All mixes named 70C and 40C reached 40 and 30 MPa, respectively, at 90 days. Mixes with EAFD showed less capillarity and no difference in water absorption by immersion with respect to mixes without EAFD after 91 days. The SCMs designed proved to be stable in terms of leaching of the heavy metals contained in EAFD, where all the hardened SCMs were classified as inert.     

玻璃体腔内注射曲安奈德联合光动力疗法治疗脉络膜新生血管所致的黄斑萎缩

目的:报道经玻璃体腔内注射高剂量曲安奈德(triamcinolone acetonide,TA)联合光动力学疗法(photodynamic therapy,PDT)治疗老年性黄斑变性( age related macular degeneration, AMD)的脉络膜新生血管(choroidal neovascularization,CNV)后发生的脉络膜毛细血管萎缩。方法:我们采用非随机回顾性干涉治疗病例。在阿利坎特学院眼科,连续观察51眼(实验组)玻璃体腔内的注射(19.4±2.1)mg/0.1mL TA联合PDT治疗AMD的全部中心凹下型CNV患者,经过2a的随访,检查黄斑部脉络膜毛细血管和视网膜色素上皮细胞(RPE)萎缩情况。同时,采用单独PDT治疗的连续30眼患者作为对照组,其年龄,性别和AMD的CNV类型及大小与实验组相匹配。结果:随访24mo后,在治疗区域21/47眼(45%,实验组)和7/30眼(23%,对照组)发展成黄斑部RPE和脉络膜毛细血管萎缩(P=0.04,卡方检验)。实验组平均最大萎缩区域的直径为(5044±1666)μm,而对照组为(4345±1550)μm。在实验组中,RPE萎缩患者的平均最佳矫正视力为(0.87±0.33),而非RPE萎缩患者的平均最佳矫正视力为(0.66±0.26) (P=0.11,秩和U检验)。结论:玻璃体腔内注射大剂量TA联合PDT治疗可能会增加RPE和脉络膜毛细血管萎缩的风险。     

No Association between Vitamin D and Weight Gain: A Prospective,Population-Based Study

Background: The association between vitamin D and weight gain remains controversial due to important limitations in the studies. We investigated the relationship between vitamin D levels and 5 and 10 years of weight and waist circumference change in a population-based prospective cohort study. Methods: Prospective study including participants aged between 35 and 75 years living in the city of Lausanne, Switzerland. Weight and waist change at 5- and 10-year follow-up were assessed according to baseline vitamin D status (normal, insufficiency and deficiency). Results: A total of 3638 participants (47.9 % women, mean age 51.6 ± 10.4 years) were included for the 5-year follow-up. No association was found between vitamin D categories and weight change, multivariate-adjusted average ± standard error: 1.6 ± 0.3, 1.5 ± 0.2 and 1.2 ± 0.1 kg for normal, insufficiency and deficiency, respectively, p = 0.159. For waist change, the corresponding values were 3.3 ± 0.4, 3.3 ± 0.2 and 3.4 ± 0.2 cm, p = 0.792. For the 10-year follow-up, data from 2999 participants (45.8% women, mean age 50.8 ± 10.3 years) were used. No association was found for weight 2.3 ± 0.4, 2.3 ± 0.2 and 2.0 ± 0.2 kg, p = 0.588, or for waist 3.7 ± 0.4, 3.6 ± 0.3 and 4.2 ± 0.2 cm for normal, insufficiency and deficiency, respectively, p = 0.259. Conclusion: No association between vitamin D status and weight or waist gain at 5- and 10-year follow-up was found.     

多巴胺D3受体激动剂对肾脏G蛋白亚基Gα12、Gα13与D3受体耦联的影响

目的 观察多巴胺D3受体激动剂对肾脏G蛋白亚基Galz和Ga13与D3受体耦联的影响. 方法 以WKY(Wistar-Kyoto)大鼠与自发性高血压大鼠(SHR)及其来源的肾脏皮质膜、肾脏刷状缘膜(BBM)以及近曲小管上皮细胞株(RPT)为研究对象,利用多巴胺D3受体激动剂PDl28907刺激D3受体,运用免疫共沉淀观察PD128907对D3受体与Ga12、Ga13的相互关联的影响,并在WKY与SHR中对比关联改变与功能差异. 结果 D3/Ga12与D3/Ga13之间在WKY与SHR中均存在共连接.PDl28907刺激D3受体后,在WKY中可明显增加D3/Ga12以及D3/Ga13之间的连接程度;在SHR中却显著降低D3/Ga12以及93/Ga13之间的连接.其中,D3/Ga13在SHR中的基础连接程度明显强于WKY,D3/Ga12连接基础状态在WKY与SHR之间无明显差异.采用PD128907直接灌注WKY和SHR大鼠右肾动脉,发现PD128907可以明显增强WKY的尿钠排泄率(FENa),但却对SHR的FENa没有影响. 结论 D3受体激动剂可明显调节D3/Ga12以及D3/Ga13之间的连接程度,该调节作用异常可能在高血压的发生发展中发挥一定作用.